I took a survey from my employer today, and as I went through the questions I was surprised by how easily I could answer one way or another. It was a survey for how the pandemic, COVID-19 was affecting us, and as I clicked each bubble I understood even more just how much things had changed. One question that stood out to me asked if I thought about work more when at home. The fact was I had always been proud of my ability to leave work at work. I am an extremely compassionate person, but after twenty years in healthcare I had learned that to keep my sanity intact, patient care needed to stay at the bedside. It would be there waiting when I returned. But today, as I pondered the question on the survey, I realized that had changed. Everything had changed.

It had really started to hit me, the weight of it all, a few nights ago. I sat in bed the night before work and I prayed. I felt so down, and the fact was I had for weeks. There was nothing wrong going on in my life. I wasn’t financially stressed. My marriage was amazing, my children healthy and adorable. I had absolutely nothing to be upset about, yet I was. The only out of place factor I could pinpoint? COVID-19.

Years ago I had come to a place in my nursing career where I absolutely loved my job. I considered patient care to be a privilege, and even on tough days I considered it a wonderful vocation. It was a calling, and I carried the task with a smile. This past week I noticed an unwelcome feeling coming over me. It was a feeling I hadn’t experienced in many years. It was dread. I was dreading the return to the critical care bedside. How could I dread something I loved so much? I cried out to God to bring back my joy for the field.

When I sat in bed praying to feel better I realized that all this was hitting me harder than I thought. I realized that even though I thought I was doing ok, I really wasn’t. Even though I thought I could handle stress well, I don’t guess I had ever experienced stress like this.

Typically, nursing is about healing. A patient comes in sick, and we make them better. That’s not COVID-19.

And yes, I had experienced lots of death and dying. It was part of the job. So it wasn’t the people dying that got me. It was the fact that most of them seemed to be dying. The ones that were in Critical Care, anyway. The prognosis of these people was horrible, and when you have to break that to a daughter who can’t talk to her mom, or even see her, it’s depressing.

I was used to elderly and debilitated patients dying, but this was different. I was seeing people my age, younger, or just a few years older, and they were not doing well at all.

Nursing had always been a career where I had to be careful with infectious disease. I frequently encountered illnesses I could pick up and take home if I didn’t use proper protection or hygiene, but this was different. It was so new, and I watched the information available change day by day. One minute it’s airborne, the next droplet. One day the CDC says one thing, the next day, something else. The suggested PPE (personal protective equipment) changed faster than I could keep up, and it became this constantly evolving situation. I sadly knew that each time I came to work things would be different than when I left.

Do I need to shower and change clothes at work? Is it in my hair? The questions I had to ask myself. Is a Level 1 mask good enough, or is a Level 3 safer? Wait, now you’re saying it’s aerosolized and I should definitely wear googles? Why didn’t anyone tell me that yesterday?

Am I bringing bad stuff home to my children? They’re so little still. The fact that our government and healthcare system was treating the response to this unlike anything I had ever encountered only added to my thoughts. I mean, your president says everyone needs to stay home. Except you. You need to run into it head on! Unless your patient’s heart stops. Then, don’t run; put on your PPE first. It was going against everything we had ever done as lifesavers!

Everyone was watching us. People whose sole job was to make sure we were protecting ourselves properly. And while I appreciated the effort, it also made you feel pretty odd. I mean, what kind of crazy crap makes hoards of upper management and administration watch your every move? What exactly were we dealing with? The answer to that seemed to change every day!

I never felt so helpless. Everything we tried seemed to be in vain. They typically weren’t getting better. One week this was the go-to drug of choice, the next week something else, and the next week the surprising news that none of it would improve outcomes. In fact, it might make it worse.

It didn’t matter that the mask or respirator hurt my face, left bruises and sores, or that it left me feeling drowsy and cloudy headed after so many hours on straight. It didn’t change the fact that I was paranoid about the seal, worried that the tiny virus could somehow get through.

The stress made me become the type of person I didn’t want to be, short tempered and easily frustrated. The high acuity of the severely critical patients forced me to become the kind of nurse I didn’t want to be, hurried, harried, just struggling to keep them alive, keep my head above the water. My shift would end and I’d be sure I had missed something, which drove me crazy, but at least they had lived through my shift. They would likely die after I left. The prognosis was always poor.

Seeing the fear in their eyes, or hearing the words, “am I going to die,” remembering those words after they were gone. Holding their hand, offering comforting, muffled words, but knowing you were no adequate substitute for their loved ones.

Speaking of loved ones. We had those too, and just this week my nine year old said sadly, “Mom, I don’t want you to go to work. I’m worried you’ll get sick.”

But then I also had loved ones who had no idea. As I was leaving work today it occurred to me that not many of my family members had called to check on me. It wasn’t their fault; they didn’t know. I had not told them the toll this pandemic was having on me, and that’s when I knew I needed to. I see Facebook posts of people who don’t even think the pandemic is real, or that it’s like the flu. They have the privilege of not knowing how hard this is hitting me and my coworkers. I don’t normally try to play a pity party or seek attention, but I realized that a lot of people just didn’t know. They didn’t know that we’re not ok.

I have spoken with my coworkers and peers, and all the ones I have questioned are feeling the same pressing weight as me. They’re tired, worn thin, worried, beyond the typical stress of saving lives on a daily basis. It’s beyond skipping lunch and bathroom breaks to keep someone from dying. That’s just a regular Thursday. This, this is different. This is harder.

I don’t know the answers, and I don’t know if things will ever be the same. I don’t know if there’s anything you can do to make it better for your nursing friends. You can pray. You can send us a message, drop off some toilet paper, or even just a long-distance hug. We need so many hugs right now, and social distancing is messing that all up. The typical outlets aren’t available to decompress, or the ways we deal with stress are not allowed. Nurses have the added weight of homeschooling, when that’s not something they are used to, or a spouse out of work. We’re dealing with all the same stress and aggravation as the rest of the population, but also the additional stress of facing this monster up close and personal.

We can’t pretend it’s not happening or busy ourselves with conspiracy theories. We’re too preoccupied with telling ourselves, “it’s not your fault. You did everything you could do.”

This is all I can write right now. There’s more, so much more, but I am exhausted after a day of the above. I need to lay down so I can wake up and do it again. See, that’s the great thing about nurses. We are not ok, but you’ll still find us when you need us. We’ll be in the clinics, ER’s, and units ready to do all we can do for those who need us. We’ll worry about us later.

First love is easy, isn’t it? With stars in your eyes and a naive nature, you swing headfirst and heart-strong into the relationship. You have dreams for the future, the butterflies for excitement to spur you forward, and even a bit of healthy hesitancy to keep you honest. But somewhere between that first date (or shift in the case of nursing) and eventual broken expectations, you end up feeling betrayed. It’s nothing like you hoped it could be. You end up disappointed, likely broken-hearted, and sadly, if your experience was especially harsh, guarded and skeptical for any silver lining that might exist up ahead. Sound familiar?

A profession you can truly love isn’t that different from a romantic relationship. It’s something that gives your life a new purpose, a reason to hope, excitement, and the ability to get better at it as you go along. It’s the chance to think of someone other than yourself, but like any relationship, the one with your career can become strained. I’ve been in the medical field for 20 years now, and I think I’ve experienced every stage of the process. I mean, if Nursing was Dante’s Inferno, I probably transversed through every circle. Y’all, I fell out of love with it, and it took purposeful determination to make my way back into my partner’s good graces. At one point, I think I hated it. Just being brutally honest here.

That first year was something, am I right? Fear, panic, but somehow an exciting adrenaline rush, a pride that I’ve discovered you can’t let slip away. I was proud to be a nurse. I was proud of my vocation, and I was proud of the hard work it took to get me there. I was proud of that R, and of that N, and for a while no one could take that from me. But then came the bad apples. Damn, if they don’t ruin the barrel.

Somewhere between holding an elderly woman’s hand and double charting for the billionth time, my heart started to harden. Do you know the difference between a good nurse and a great nurse? I was always a good nurse. I took care of my patients, and I got the job done. I was honest (for the most part), and I did no harm (that I’m aware of). I smiled at my patients’ faces, and I even meant about 80% of what I said. This will sound so harsh to the layman, but my fellow nurses will understand. It’s not easy giving all of yourself with little to nothing in return. I mean, yeah, you get the paycheck, but that even seems paltry in the face of preventing death or giving up Christmas with your family. So, it becomes a job. A thing you do, day in and day out. I can even recall telling my husband I felt stuck. Lord, help me, I did. I could think of no other “job” where I could work 24 hours, yet get paid for forty hours, while maintaining the best benefits offered in our little city.

I ask again, do you know the difference between a good nurse and a great nurse? A good nurse gets the job done, but a great nurse loves the job they get to do. I guess I had to move from one to get to the other.

All I know is, I entered the field like a young, star-crossed lover, but about a decade into it, I wanted to breakup. I had become disillusioned, and it wasn’t what I thought it could be. Maybe I entered the career thinking I could make so many differences, but I wasn’t open to what could change in me. I became a woman focused on the obstacles before me, and blinded to any blessings scattered throughout. I wasn’t heartless, mind you; I still felt contentment when a patient told me how much my care had meant to them. But those Hallmark moments couldn’t outweigh the injustices I felt. I focused on every single hardship in my field, and I took personally each offense. I allowed the Negative Nancy’s to feed the fire of bitterness inside me, and I assumed every demanding patient canceled out the kind ones. There’s certainly that need for self-care, but I think I came to a place where it was almost always about me.

“Why is this so hard,” I asked, never contemplating for very long how it must be on the other side of the bed.

“What do they expect of me,” I would question angrily, without asking myself what I might give.

I saw my field only as a difficult endeavor, and seldom as a privilege. I carried the weight of a thousand martyrs, except I had forgotten the cause for which I gave myself. I was a good nurse, who did my job, but not a great nurse who loved the opportunity to do it. And I suppose that’s many of us. It’s not that we don’t enjoy what we do; it’s just that sometimes we hate it just as much. That sounds so terrible, when I type it out like that, but if you’ve never held a position where you don’t cry while cleaning the dead body of someone you just hugged that morning, then you may not understand. If you haven’t been punched, kicked, or called the worst of all swear words by someone you’re trying to help, then you won’t get it. If you haven’t cringed over calling someone in a position above you, knowing they will scream at you merely for doing your job, then this may seem like harsh words. If you haven’t felt the anxiety of trying to do the work of two people, while not making a mistake that could cost someone else’s life and your career, then you just won’t have a clue. It’s not easy to carry the weight of so much on tired shoulders, and for many who do, they end up angry and perhaps even resentful for a profession they once loved so much.

Back to the relationship bit, it’s as if the marriage is falling apart, and you don’t want a divorce, but you can’t look at his socks balled up on the floor another day or you might snap. I guess sometimes, when you realize you don’t love them like you used to, you have to take it back to the beginning. You have to remember the first time you saw them, that first date, or first, tender kiss. The spark is still there. You just gotta know how to stoke it.

I recall sitting in a computer class taking a critical care course, and I was digging it. Us Critical Care folks, we love all that medical stuff! Sitting there, I knew I loved the knowledge. I loved the dynamics. I loved the process. I loved the people. I loved making a difference in people’s lives. I loved nursing. I did. It was time to act like it.

Back when my husband and I were just dating, I remember we had been off again, on again, at one point. I had found out some stuff, and each of us had been idiots. We loved each other, we knew that, but we were kinda just coasting along, existing as a couple. Like, maybe involved, but not committed entirely to the future of it. Well, anyway, I remember standing in the card aisle on Valentine’s and I had found the perfect, mushy card for him, when suddenly God smacked me upside the head.

It was like, God said, “Brie, if you’re going to give that to him, you need to mean it.”

And I was like, dang, you’re right. I love him. I really do. We can work through this.

And we did. Every day since our relationship got better, and even now, each day is better than the last. I guess, I had to come to a place in my nursing career that was similar. I loved it, but I had to start acting like it. I had to do more than just show up. I had to get invested. I couldn’t focus on my husband’s faults, any more than I could deny my own. And I couldn’t selfishly fixate on what nursing took out of me. I had to start giving of myself more. I had to see through clear eyes. If you focus on a stain, that’s all you see. What you should look at is the fact that the fabric is still good. It can be washed. Nursing was still good. I think my vision of it had just become tainted.

My career truly began to change when I focused on the opportunity to provide care, the privilege of meeting people at their darkest hour, and leading them back into the light. I threw off sympathy and instead embraced empathy. I put myself in my patient’s shoes. Heck, even the administrators’ shoes. I saw my occupation as the ministry it was, my chance to care for the hurting, and to help those in need. I didn’t face the relationship with what I could gain, but what I could give. I didn’t focus on what wrong was being done to me, but rather what good I could sow into it. Y’all, I fell in love all over again, and it wasn’t because the object of my affection was perfect, but because it gave me purpose, passion, and a sense of fulfillment. Was it still hard, at times? Yes! But beyond that it was good. In fact, it was great. And then I realized, I was great too.

Before I started my most recent travel nurse position in a Cardiac Critical Care Unit, I had to complete some online education and checklists to prove I was proficient in the knowledge and skills I claimed. As I went through the skills checklist marking “very experienced” on almost all of them I felt a surge of adrenal. Seeing the scenarios in print made me feel like I was almost doing them, and I realized I was excited at the thought.

I frigging love this stuff, I thought.

And it surprised me a bit. At the time I was back home on vacation, lounging in my pajamas, with hardly a care in the world other than the email from my compliance office of things I needed to complete for my next assignment. But rather than being perturbed over the intrusion of my off time, I was eager to get back at the bedside. I suppose that’s what really surprised me. I wasn’t dreading returning to work as an ICU RN. I was eagerly anticipating it.

It’s not that I didn’t love my time off. Of course I did! But I also loved taking care of my patients. The thing is, it had not always been this way.

Don’t get me wrong, now. It’s not that I hated my patients. I had always enjoyed caring for people, but somewhere in the frustration over increased charting requirements, low staffing, and bosses who forgot what it was like to be at the bedside, I didn’t enjoy it as much as I wanted to. In fact, some days I had right near hated it. Some days I drug myself home and wondered how much longer I could make myself stay at the bedside. It became an exhausting, exasperating exercise in what felt like futility. Between the noncompliant patients and family members you couldn’t please, I was burned out. This made me sad. Not only sad for myself, but also my patients. They deserved more from me.

It got to where every little thing made me furious. Another “mandatory” meeting? Oh please. The double charting of restraints made me fume. New policies caused me to roll my eyes, and I got on the bus that no one cared about the bedside nurse. No one! I was a body, a number, a workhorse to be used and abused by surgeons with a god-complex. Whatever.

I dreaded going to work, and I didn’t want to be a nurse anymore. It broke my heart. I had always wanted to be a nurse, like my mother, but I told myself the field of nursing had simply changed. It wasn’t the same, and because of that I’d lost my spark.

I ended up taking a step back. I cut down my hours, and thankfully financially I could. I focused on raising my babies, and that was where my joy was. It worked for me. But I was still sad about the time I did work. Something wonderful would happen. A patient would tell me how I had changed their life. A family member of someone who almost died would spot me in the store and suffocate me in a grateful hug. A former patient would bring a gift by my husband’s work for me, and brag about the care I had provided in their worst time. I felt overflowing with pride at theses situations, but I also felt like a fraud. If these people could see how frustrated I had become at the field, they probably wouldn’t feel the same about me. No matter how kind and cheerful I remained at the bedside, I wasn’t blind to the bitterness that had crept unwanted into my heart.

And then came the time for me to return. Seasons changed, circumstances altered, and I found that a full-time return to the bedside was required.

I can do this, I thought.

I wanted to do it. But I also wanted to not hate it. One day I stood in the hot shower, extremely exhausted from my prior shifts, and I began to pray.

“Give me a joy for it, Lord,” I prayed.

That’s what I wanted. I didn’t want to just get by. I didn’t want to just be able to endure. I didn’t want to do like so many other of my fellow Americans and just countdown the days until I could retire. I wanted to love my job again. We weren’t made to trudge through life miserable. I mean, life is not easy. That’s the reality of it. But it does make a difference how you view what’s before you.

The fact was nursing had changed. I had seen it change drastically just in the past decade. There were frustrating things about the field. But there were frustrating aspects of anything. My kids could ruin a fun day with fighting and complaining, but I didn’t stop taking them places. I focused on their happy smiles, not their tired whines. I focused on their “thank you’s” and “this is the best day ever’s” rather than the pulled hair and dirty tears. That’s how I had found joy in the difficulty that’s parenting. It’s how I could find joy in Nursing too.

I began to see things differently. Instead of focusing on frustration solely, I focused on the parts that gave me happiness. I counted it all as joy. I saw myself as a servant, not a slave. I saw myself as a helper, not a doormat. I saw myself as a lifter of spirits, not one crushed by my own bad mood. I recognized the gift of what I did. I had the privilege to care for people when they needed it the most. I had the lofty task of saving lives, of changing lives. I had the opportunity to positively impact people at a time when they were at their lowest and most vulnerable. I had a chance to shine.

Did some days still suck? Of course! But underneath it all was joy. Joy that I got to be a part of something pretty darn amazing. I could make a scary situation a lot less frightening for someone. I could pull someone from the brink of death and watch them walk out of the hospital a week later. I was a ringside witness to amazing technology that could give a goner twenty more years. I got to be a part of some pretty spectacular stuff, and I got to smile and be loving to people along the way. It was a choice. And I chose joy. By God, I chose joy.

That was just the beginning, though. It was like, the more I walked in joy, the more I felt joyful. The more I focused on the good stuff, the less I saw the bad. When people griped, I walked away. I sang a happy song to myself, I had a conversation with a lonely old lady, I taught someone something new about their health, I lent a hand to a drowning, new nurse. I smiled. It wasn’t that I was blind to the problems inherent in my field. I wasn’t sticking my head in the sand. But I was seeing more than the suck. The joy was there all along. I had just forgotten how to see it. I had been blinded by my own indignation, side swiped by injustice, defeated by the doomsday talk, the wind sucked right out of my sails. But then I found it again. I found my love for nursing again.

Again, it had always been there. I hadn’t changed. The field had changed, but I didn’t change along with it. I didn’t adapt. I stood rigid. And yeah, some things I needed to stand firm on. Nurses did have rights. But we also had responsibilities. It wasn’t the dying man’s fault the budget had been cut. It wasn’t the lady with a STEMI’s fault that Medicare had changed. They still needed my best. They needed a woman who wanted to be there; not just a woman who wanted a paycheck. To be that woman, the one they needed, I had to put my focus on the people who needed me. I still saw the things that needed fixing in healthcare, but I didn’t let those overshadow the joy that came with making someone feel better.

Making someone feel better! That was the best of it. That’s where the joy was, and that’s where I found it. I reckon you can find joy in almost any circumstance. You just have to be willing to look.

These were the words I spoke to my husband, and it surprised even me that I had spoken them out loud. Yet there they sat, out in the open, uttered in angst, and unable to be taken back. It was true, though, and even as that saddened me, admitting my frustration was freeing.

In all honesty, at that moment, I wished I could just stay at home. With young children, that’s where I wanted to be at the moment. I envied those women who could lament over daycare being too expensive to justify working out of the home. I held a job that brought a substantial enough income that my paycheck outweighed what I might have to pay a sitter, and while that didn’t sound like a problem to most, as a burned out nurse I was just looking for any old excuse to be able to step away from the bedside. As it stood, I had built a life (and the bills it included) around my salary as a nurse. I depended on my payday to make ends meet.

I was stuck in the life I had created. I was working twelve hour shifts at the bedside because the schedule I could create worked best for my family at the time, but even that wasn’t enough to make it worthwhile for me. I was exhausted with homeschooling and staying up with a baby. Dragging myself to work in between my home responsibilities was just too much. I dreamed of being a bartender again, or even working in a PVC pipe factory like I had at the age of 22. Anything sounded better than Nursing. I regretted that I had ever left vet med school to pursue a career caring for humans.

This was where my mind was five or six years ago, and I think if we’re being honest, we’ve probably all been in this place of our career at one time or another. It’s that barren place where the good doesn’t seem to outweigh the bad much anymore. Nursing is often a thankless vocation, and one day you look up and can’t remember the last time it seemed rewarding more than exhausting. After all, the hours were long, the patients were often overly demanding, the families unrealistic in their expectations. The charting had quadrupled, the staff had been cut in half, and the responsibilities multiplied. And the fact that by responsibilities we were talking life and death, that didn’t help matters. Even if you were exhausted, you couldn’t allow that to affect your performance. Otherwise fatal consequences could ensue. That would wear thin even the most sturdy individual.

Nursing was hard, no matter how you looked at it, yet you still loved it. Deep down, in that place where the light that loved Nursing still burned, you enjoyed the field. It just seemed burnout could cause the flame to flicker. It brought frustration, often, but occasionally even regret. Why did I ever become a nurse?!

Last week I walked into the room of a chronically ill elderly woman. I knew in my heart she wasn’t going to get better, and I think she did too. I had taken care of her a handful of times, including her first day admitted, so we held a special bond. In her prior moments of fear I had offered comfort. She liked it when I sang or hummed softly while attending to her needs. She said it calmed her nerves. To see her genuine smile when I walked in the room was nice, and seeing her daughter’s joyful reaction to my presence added to the feeling. Once outside of the room, the eldest daughter and I, we walked in silence to the ice machine, acknowledging without words the fact that mom was looking worse. We came across her physician in the hall, and together we all advocated for her care. I beamed with a contented feeling of accomplishment for getting my patient what she needed. It felt good to do good, if that makes sense.

Later, when I returned to my familiar patient’s room she commented, “you know what I’ve noticed? It always seems like God puts people exactly where they need to be exactly when they need to be there.”

It was an “aha” moment for me. She wasn’t just talking about the doctor, but also me. I was right where I needed to be, and not just on that particular day with that particular patient. I was right where I needed to be caring for people in their most vulnerable and difficult times. I was using my gifting to help others, and with that came a sense of purpose and feeling of pride that far outweighed any passing emotion of regret I had felt in the past. Over the past year or so my heart had changed. It had turned back to Nursing. The passion and calling that led me to the field had returned, my joy for the job had increased, and my flame had been rekindled.

Nursing is a challenging job, but more so than that it is a responsibility for the lives of others that can easily leave you exhausted and disillusioned because of the demands that weigh heavy on your heart and mind. Without the perspective and awareness of the valued part you play in changing and improving lives, you can easily come to a place of burnout, and possibly regret. At this point I’m grateful that my candle no longer flickers, but instead burns bright. That’s not to say I don’t get tired, frustrated, and stretched far too thin, but I am able to realize with pride that I have been placed exactly where I need to be, at exactly the right time.

It had been a long day. I guess anybody that works twelve hours will say that, especially when it’s really 13-14, but who’s counting, right? Plus it had been a chaotic day, one of those days where the patients without adequate pain medications ordered are suddenly writhing in pain, or the kind of day where your patient gets extubated and reintubated all within the same hour. Yeah, a day like that. It was one of those days where you hug and kiss on the cheek of a grieving wife, and one where the loss you’re surrounded with at work makes you melancholy for family you’ve lost personally throughout the years. Yep, it was a very long, physically and emotionally exhausting day.

For me, though, life exists beyond the bedside. So after a 13 hour day I’ll think of an errand I need to run, and with two baby showers in the next two days a quick run to the store was in the cards for me this particular night. I drove the short distance, thanking the Lord it was short, and tried to focus. The thing was my brain felt fuzzy, kinda foggy, and it took a bit of concentration to pay attention to traffic and compose a shopping list in my head. I honestly felt beat. It seemed like every light cruelly turned red, or that cars in front of me refused to go something even resembling the speed limit. They puttered along oblivious to my exhaustion, and I realized at that moment I’d give a small fortune just to go straight home.

Once I’m in the store I quickly try to grab some ingredients for an easy yet delicious party dip. I backtrack through aisles for things I missed. I stand near the salad dressings looking for soup mix that wasn’t there and I ask myself, what in the world are you thinking?!

Finally I have my merchandise all collected in my basket and I make my way quickly to the checkout. I try not to curse under my breath when no express lanes appear open, and I shuffle resigned towards the long line coming from the one open lane. Here’s where it really starts to unravel.

As the checker asks kindly for my discount card I rattle off an old number not even attached to my current, customer rewards account. I rack my brain for the right number and recite it eventually. But it’s at this point that I realize I forgot a gift card. I look eagerly and desperately for what I need to be nearby.

“What kind of card are you looking for,” she asks kindly.

“A Visa gift card,” I answer quickly, not wanting to hold up the line.

“They’re right there on aisle three,” she offers.

I rush off towards a display of gift cards on the next checkout aisle. I see a plethora of restaurant selections, but that’s it.

In the background I hear, “aisle three.”

I stumble off frantically towards checkout 3, looking up towards each checkout light. 5, 6, 7. I realize I’m headed the wrong way and change directions to make the numbers go down, but I begin to get more frustrated when I realize only Amazon cards reside along the checkout lane marked with an unlit 3.

I look dumbly towards the numbered grocery aisles and an end-cap of hundreds of gift cards look back at me. I race towards them mumbling to myself, feeling quite stupid, and I scan up and down, up and down, but no Visa gift cards.

Beside me steps the same checker, “here you are. They’re right here.” And she easily finds a display of Visa and MasterCard gift cards to my left.

As I later shambled shamed out of the store I realized that I was basically useless after a twelve hour shift at the critical care bedside. Thankfully, I was abundantly present while there. In fact, it was like I was always on point, ever watchful, and constantly on guard just in case my patient headed south. And maybe that’s why I was like a head full of mush once it was all over. After being at the ready for an entire nursing shift, I required a good unwinding and solid night’s sleep before doing it again. It amazed me to think of the serious issues I managed while at work, yet how I crumbled in the face of a grocery trip afterwards.

I felt almost sorry for my young kids who had to put up with me once I got home. I would throw together a quick supper for myself. Thankfully my husband had already fed the children. And then I would sit useless on the couch until I passed out for bed. They would ask me to play this or that, but other than cuddles I was basically beat. I was grateful I only had to pull three of these shifts a week, for my sake and my family. It was beyond exhausting. It was emptying. It totally drained me.

On this particular night, as I changed into my pajamas, I remembered that I should sign the note to accompany my gift card I had purchased for the baby shower the next day. So I fumbled through the kitchen looking for the card, and it was at that point I realized it was nowhere to be found. My mind went backwards to the checker scanning my gift cards. My other purchases already waited in a grocery cart.

“Do you want to hold these or me put them in a bag?” She had asked.

“In a bag is fine,” I had answered quickly.

And in a bag, at the checkout, they had remained. I couldn’t even be surprised that I had neglected my hard-fought gift cards and left them behind.

We’ll just call it shift brain: the waning remainder of mental capacity following a long, trying, nursing shift.

I am ashamed to say that I stood in the shower recently before work and other than offering up the usual prayers for a smooth day I actually made a very specific petition for divine intervention. The day before I had helped a coworker with a very unstable patient. I had watched him run his legs off trying to keep this patient alive, and I just wasn’t up for taking the reigns on that one in his absence. I was tired, and the thought of the serious mental concentration that would be required to combat the patient’s labile blood pressure and respiratory distress for thirteen hours wasn’t something that made me want to turn cartwheels. In fact, I wanted no part of it this particular day.
I work in critical care so I’m used to critically ill patients, and yes, that’s just part of it. But I think any nurse will tell you that some days your brain just wants a breather. The thing is we don’t talk about it out loud that much, but the profession we have chosen comes with a mountain of responsibility. Yes, it comes with loads of rewards, but it’s also a bit frightening when you think about it. So typically we don’t. We just do our thing. It’s our job, right? But what exactly does that entail?

Let me tell you a story. I remember once having a patient on the ventilator. He was receiving a large fluid bolus, and though I was close by things happened pretty quickly. I looked up from my seat outside his window and noted the oxygen monitor on his finger suddenly not picking up properly. When I entered the darkened room I was confronted with a huge purple hand. His circulation was compromised and I couldn’t feel or even doppler a pulse. A nearby physican even got excited when I called him to the bedside, and he started contacting the orthopedic doctor on call. It looked like Compartment Syndrome and perhaps a surgical intervention was going to be necessary to save this patient’s limb. Intubated patients can’t tell you it hurts. I wondered was it broken, or just an infiltration gone bad, and should I have caught this sooner?

It happened so quickly, and the crazy thing was that for critical care this patient was incredibly stable. Everything was smooth sailing, but all it took was a moment for things to turn south. The patient was fairly young, and all I kept thinking was, this guy may lose his hand, and it will be my fault.

That’s the truth about nursing that most of us don’t talk about. We don’t talk about it because if we did it might frighten us from the bedside altogether. Simple things, the tasks we take for granted as being second nature, those small things are even big things. A simple med pass can end in a serious allergic reaction, or God-forbid, a deadly medication error. A walk in the hall can become a sentinel event if nonskid socks aren’t worn, or something as easy to do as forgetting to put the call light within reach can lead to a head injury. The everyday nursing task of giving IV fluids can turn into an amputation.

For my patient that day the problem resolved as quickly as it had occurred. After the fluids were stopped, IV removed, and the arm elevated the circulation was restored. No tissue damage incurred, and what could have been a terrible occurrence never resulted in more than a mild, visible swelling by the end of my shift. But it was a reminder of the truth. As a nurse you can never let your guard down for even a moment.

I think of all the shifts over the years where I skipped lunch. Not because I wasn’t hungry; I was, but because I just didn’t feel like I could leave my patient’s side. It didn’t feel safe. There’s not always someone to watch your patient assignment for you. They have their own.

The truth of nursing is that it’s more than just a job. When you walk into the room and accept your assignment you are accepting responsibility for another person’s life. Sure, you’re not a man on an island with no help in sight, but as your patient, the person in the bed is your ultimate responsibility. So if you’re not feeling well, tired from being up with a teething baby, or distracted by personal problems at home, it doesn’t matter. Your responsibility is the same despite your capabilities that day. There becomes no such thing as simple oversight when life and death are on the line. Not being melodramatic. Just keeping it real.

Your mind must work on overtime, thinking not just of the task at hand, but anticipating unforeseen complications or possible outcomes of the intervention you’re considering performing. In critical or emergent situations your mind is not allowed to stop thinking this way. It must continue thinking through every possible scenario and snafu until it’s relieved by another fresh mind half a day later. Whew.

Some days all your patients are golden. Everything runs smoothly and patient presentation is practically perfect in every way. On those days it seems like your job is pretty easy, except for the fact that you always know deep down. You know that you can never fully relax or let down your guard because it could change in a second. It only takes a moment for a heart to stop beating.

So the weight of that responsibility can be pretty heavy some days. The truth can be taxing, and maybe you want a break for your brain. To my fellow nurses I would say, there’s nothing wrong with that. Sometimes it’s okay to speak the truth. It’s a relief even.

Today I woke up pretty late. I had gotten a good eight hours of sleep at least, and I should have felt rested, but I did not. I never did the first day following my stretch of twelve hours shifts as an RN. That’s just how it was.

As I stood in front of the mirror some time later, after a huge mug of coffee and a refreshing shower, I grimaced at my red eyes. I tried lubricant drops and even Visine, but it was pointless. My eyes felt gritty and sore. And that’s just how it was.

That’s how my eyes felt after working all weekend. My mind felt much the same, like no amount of lubrication could quick start it. Something about it reminded me of the morning after a long night of partying in my twenties, and it would take a day to get over it just like it did back then. You see, I was suffering from a Nurse hangover.

I’ve had a lot of different jobs in my day. I’ve waited tables, car-hopped, and tended bar. I’ve been on an assembly line in a factory and dealt with retail customers on Christmas Eve. I’ve worked third shift, night shift, and split shifts. But nothing, I tell you nothing makes me feel quite so haggard as a string of consecutive nursing shifts at the bedside. Something about it wears me out.

I look at the roadmap of veins on my legs, left there before I had the foresight to wear support stockings, and I know it’s physically demanding. My co-worker’s recent back surgery tells me that’s the truth, but I think there’s more to it. I’ve been physically challenged to the point of injury when I was in boot camp, but the weariness I feel after thirteen hours bedside is an animal all its own.

No, I think a nursing hangover is one part physical, two parts mental, and smattering of emotional fatigue thrown in for good measure. A typical day at the bedside will certainly leave you with sore feet from standing and running all day, but the mental exhaustion of remembering medicine side effects, titration volumes, and physical symptoms of any given disease process would leave even Einstein frazzled. And even if everything is going smoothly there’s always the chance of rain. You set at ready at all times so even when it’s “quiet” or “slow” you can’t really relax. You know it could fall apart at any moment, and that’s exhausting.

Top it off with the emotional stress of death and being strong in the face of grief, and any pastor would crumble. When you realize there’s some situations you cannot change no matter how hard you try, it’s supremely draining. My most exhausting day to this point remains the one where I cared for a young postpartum mother whose baby had been stillborn. I watched her hold that infant all day, and I just held her hand and my tears. There was nothing more I could do.

So factor in the things you cannot change, the illnesses you cannot treat, the noncompliant patients you can’t convince, or the unrealistic demands you can’t possibly fill, and you’re left with the wind sucked from your sails. You’re left adrift on adrenaline that can only drive you for so long. You clock out, drive home on some God-given autopilot, and pass out on a pillow of sheer exhaustion. Do that for another day, or two, or three, and you’re rewarded with a hangover that could beat out Jose Cuervo eight days a week.

I make a great salary. The hospital I work for is awesome. The patients who smile and comment so sweetly about me make my day. I had adorable, dream patients this weekend, in fact. Those things keep me at the bedside, well that and my passion for helping others. But none of those things change the point that I’m beat today on my first day off. I guess that’s just how it is.

I was sitting at my computer screen, entering orders for a physician, and trying not to forget what he had said since I had neglected to write it down. I was charting my note, mentally taking inventory of all the tasks I had accomplished and problems I had identified and reported. My eyes felt gritty and my mentation frazzled. I glanced at the time on my computer screen and was taken aback that seven hours had flown by so quickly. Then I realized with dread that I hadn’t documented a single thing on my other patient. I was so behind!

And as my sand-filled eyes started to water in the frigid air of my surgical ICU I realized I was beat. I was exhausted. Yet I had not been working all week. It was my first day on shift in two weeks! I knew, though, that nursing wasn’t so much exhausting because of the hours worked, but rather the work that was performed.

Yes, twelve hour shifts actually turn into thirteen and sometimes fourteen hour shifts, and by golly yes, that makes for a supremely long day! But you only have to do that for three days, right? Maybe four. The rest of the week you’re free and off jet-setting the country, leaving a trail of money in your wake as you go.

Yeah, right.

More like curled up under the covers in a dark room, recovering from a mental and emotional hangover much worse than one caused by the cheapest of Tequila.

As I sat at my computer screen fighting my mental and physical fatigue I knew the reason I was utterly exhausted, and although by most career standards my day should be coming to an end, it wasn’t even my lengthy shift still looming that made me want to wave my white flag of surrender. My patient was critically ill, and as such I had not stopped.

I remember in high school I ran track. Never one for speed, I was more of an endurance runner, and as a long-distance runner I can recall the trip around the half-mile track. After so many loops you’d get to a point where you were done. You were finished, in your mind and rubbery legs, and you felt certain you could go no further. You’d strive for that line up ahead that marked the finish, head down, legs pumping, and when you got there you’d realize you still had one more lap to go. One more lap, you’d whisper encouragingly to self, and by sheer adrenaline you would continue.

That’s kinda how nursing is. You go and go and go. You fight and fight and fight. You rush and rush and rush. And just when you think you may be done, you are not. The next shoe drops, the next set of vital signs plummet, the next patient falls, the next train wreck codes. On, and on, and on.

In few other fields will you find that the moment you hit the wall does not matter. Like a soldier into battle (and as a veteran I think I can speak on this), a nurse holds life and death on the line, so when your brain becomes fried and your body becomes weary, you just keep marching to the drumbeat of beeping IV pumps, shrieking monitor alarms, and persistently cruel call lights.

Nursing is exhausting for so many reasons, but the biggest being the task at hand. You work within the confines of time, pushing the limits to complete an enormous workload with minimal support staff available, all the while carrying a small library of knowledge within your overloaded brain, realizing that an error on your part could be detrimental.

You complete one job and another comes along, and much like an assembly line worker in a factory you keep going to prevent the great machine of healthcare from going on the fritz. Yet you also know if your machine stops so does someone’s heart, and if that’s not mentally draining then I don’t know what is.

So even one full day as a nurse, especially on a tough day, can seem akin to purgatory. That’s not to say that being a nurse is similar to torture, but anyone who’s begged the time clock to bring along the next shift knows exactly what I mean. You see, when you’ve mentally thought your way through keeping someone alive as long as your fizzled out mind can handle then a ten hour break away from the bedside seems like a much needed respite.

And yes, even working “just” three days a week is utterly exhausting.

Meet Brie

Brie is a forty-something wife and mother. When she's not loving on her hubby or playing with her three daughters, she enjoys cooking, reading, and writing down her thoughts to share with others. She loves traveling the country with her family in their fifth wheel, and all the Netflix binges in between. Read More…

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